Free Falling
Vogue | December 01, 2008 | Dederer, ClaireStricken with a case of the chronic spins, Claire Dederer searches for a way to make her world stand still.
I never know when the dizziness will hit. The mere act of getting out of bed in the morning can set off a poisonous spin in my head. Pulling the milk jug from the fridge is risky; it can end with me sitting stunned in a white puddle. When I go for a walk in the mountains beyond my backyard, sometimes the path begins to wiggle like a snake, and I fall to my knees. I'm dizzy when I hug my children. I'm dizzy when I cook over a hot stove. I'm dizzy when I have sex with my husband. I am dizzy while I write this and, it's a safe bet to say, I'll be dizzy when I stop.
I've been fighting chronic dizziness for the past fifteen years, and mostly losing. I'm not alone. An estimated ten million Americans see the doctor each year for similar problems. The Vestibular Disorders Association, a national advocacy group for people with inner-ear and balance problems, gets more than 100,000 visitors to its Web site (vestibular.org) every month. And yet, despite the cries for help, dizziness as a medical phenomenon remains mysterious, confusing, and frustrating. In many ways, dizzy people are in the same spot depressed people were 20 years ago: isolated, invisible, and sometimes perceived as responsible for their own condition. While a recent surge of new research has started to clear up some of the mystery hanging over this disorder, much is still unknown.
The confusion over dizziness starts with its name. Dizziness isn't a medical term. It's a catch-all for any number of sensations, which include feeling lightheaded, sensing the room spinning, or enduring a constant rocking sensation, as if you were trapped on a ship to hell. Vertigo the label the doctors used to diagnose me is, on the other hand, a medical term. Although many people think of vertigo as a fear of heights, as in Hitchcock's film, it actually refers specifically to the sensation that the room or the head is spinning.
When a person with vertigo seeks medical help, she usually doesn't find clarity or even solace. A medical-textbook chapter opens with these words: "The problem of dizziness is one of the most exasperating in the practice of medicine." Jonathan Olshaker, M.D., chair of the emergency-medicine department at Boston Medical Center, lectures other physicians on treating the dizzy patient. "If you give residents a choice from a pile of charts," he says, "the last one they're going to pick is the chart of the dizzy patient. I always say dizziness causes fear and nausea and panic and that's in the physician."
The first time it happened, I was 24. It was the early nineties in Seattle. Mudhoney and Nirvana were playing at small clubs almost every night, and I was making a career of going to rock shows. So when I woke up feeling a little dizzy one morning, I chalked it up to beer and amps. Then I tried to stand up.
The room passed by my eyes in short, tight, viciously organized bursts, always rotating in the same direction. I lay down. I stared at a fixed point. I stayed there, for days. On day three, I finally made it to the doctor, who gave me some ineffectual motion-sickness drugs, asked if I was stressed, and sent me on my way. Back to bed again. On day five, I staggered down the street to the local cafA[c] and ordered a plate of fries. I noticed the other diners looking at me, and not in a good way. I was listing to one side in my chair, clutching the edge of the table. I was dropping French fries and staring determinedly at a fixed point, so as not to tip over. I looked like a nut, or a dipsomaniac.
"I always say dizziness causes fear and nausea and panic and that's in the physician," says Jonathan Olshaker, M.D.
A week or two later, the dizziness had gone. I thought it was a goofy fluke, a funny story to tell my friends. I was wrong. Over the next fifteen years, episodic vertigo would visit me again and again, an unwelcome and drastically unsettling guest.
Anyone who has a chronic condition is forced to learn all kinds of anatomy that she'd just as soon not know. What I've learned over the years is this: Balance is a three-legged stool. You need all three legs in order for it to work. One leg is sight. Visual cues help you balance. Another leg is called proprioception. This refers to the sensors in your muscles, bones, and nerves. When you're standing, for instance, your feet sense information about the ground, and this information helps keep you upright.
The third leg is your vestibular, or inner ear, function. This isn't the most crucial leg of the stool, but it's the one that most often goes out of whack. Your inner ear has a central chamber, rimmed by hairy cilia. Suspended in these cilia are tiny crystals that give information about where you are in space. Branching from this main chamber are, in each ear, three canals. Sometimes the crystals float free of the cilia and migrate into the canals. (Doctors always use that word, migrate, as if the crystals were in search of a better life.)
Once the crystals have made their journey to the canals, you are, in the medical parlance, screwed. Dizziness caused by crystal migration is the most common form of vertigo. It's called benign paroxysmal positional vertigo: benign because it's not caused by a stroke or a tumor or any of the other big boys of brain disorders; paroxysmal because you experience the vertigo as a series of attacks; positional because the dizziness strikes only when your head is in specific positions; and vertigo because your head is spinning like a clothes dryer.
I know whereof I speak: I have BPPV. It was a long time before I figured this out, though. Every few months I would visit my doctor, who would ask gently if I was stressed. As the years went on, I grew more worried and demanded more tests. Dizziness can be caused by a stroke; my MRI came out clean. It can be caused by MS; I had no other symptoms. It can be caused by MA[c]niA[umlaut]re's disease; I didn't have the accompanying tinnitus.
Finally we hit upon BPPV, after I heard about it from a friend. This is not an unusual pattern for a dizzy patient. Diagnosis seems often to be random and chance-driven. Doctors and physical therapists and mental-health professionals parade in and out of the dizzy person's life. In the past, dizziness was closely linked with neurosis. In fact, it's been linked with all kinds of crackpot theories. Freud believed it could be caused by coitus interruptus.
Despite Freud's long shadow and my doctor's persistent concerns about stress, I never sought a mental cure for what I felt sure was a physical problem. Instead, I held my head as still as possible and went about the business of life. Certain niceties fell by the wayside. Here's something BPPV sufferers don't know: what's under their couches. The bend-twist-and-peer combination required to clean beneath furniture is perfectly designed to cause a wicked spin. Other sacrifices were more difficult. I longed to pick up my children and hold their wriggling weight in my arms. But that was out of the question. What if I fell?
Finally, about five years into my ordeal, I was sent to a neurologist who was one of the only people in town who knew how to perform something called the Epley maneuver. It sounded to me like some kind of delicious space-age massage. This did not turn out to be the case.
The wild-eyed and overbooked neurologist briefly examined me and then strapped an enormous pair of goggles to my head and informed me I was a good candidate for the Epley. "Come this way," he said abruptly.
We went into a dark room and blindly bumped our way to an examining table.
"Now I am going to perform the maneuver," he said. It would've been a naughtily sexy moment except that it so entirely wasn't.
He seized my shoulders and pushed my torso onto the table in one strong motion. I felt like a side of beef. The room spun. Then he flipped me across the table onto my other side, and then I lost track of what was happening as I was whirled into a maelstrom of dizziness.
"That's it," he said suddenly, in the voice of man who had done his worst. "Call us and let us know how you feel."
I wanted to yell at him, as if I were a Mafia don and he was my bungling henchman: "How do I feel? How do I feel ?" How I felt was dizzier than ever.
I avoid activities that turn the universe upside down. quit doing backbends at yoga. I don't unload the dishwasher. I don't look at clouds
The Epley, I found out later, is designed to knock those errant crystals back into place. In the years that followed, I experienced the Epley many times. The treatment has become widely used, and I received it from competent physical therapists rather than my crazed neurologist. While it was never pleasant to be flipped around on the table, the therapists made it seem more like a cure and less like kung fu. The Epley didn't entirely work for me, but it cures up to 80 percent of people with BPPV who undergo it. In a medical field clouded by mystery, these are astonishing results, justifying a turn away from the psychological treatment of vertigo to a physical approach.
A growing number of family doctors are using the maneuver (also known as canalith repositioning) to good effect. And more studies are being done: Last year, Canadian researchers found that after the third treatment in a family-practice setting, up to 75 percent of patients improved. And a new guideline from the American Academy of Neurology recommends the maneuver above all other treatments. Meanwhile, for patients who don't have BPPV, doctors and physical therapists are working on an ever-widening range of exercises that can help a dizzy person get used to being dizzy, or, as a recent study has shown, can even help her overcome her disorder.
I have yet to find the maneuver or the exercise that does the trick for me. So I do what all dizzy people do: I avoid activities that turn the universe upside down. I find that this list gets longer all the time. I quit doing backbends and headstands at yoga. I quit talking to people unless they're right in front of me; twisting my head is unbearable. Running is good (something to do with gazing into the middle distance); ball sports are bad. I don't shower when I'm in the house alone. I don't unload the dishwasher. I don't look at clouds. I don't lie on the ground on a summer day and gaze up into the moving, shadowy branches of a tree.
The main thing is to remain vigilant at all times. When the room starts to spin, I sit down or drop to my knees and hold perfectly still, my gaze focused on one thing. Usually the attack passes in a minute or two. Sometimes it can last as long as a day, during which I have to lie down and remain as motionless as possible. As I lie in bed, my husband, a largely sympathetic human being, sometimes looks suspicious. I am, after all, a person who has historically adored lying around in bed. In the teeth of the spin, it's difficult to care what he thinks. When the vertigo has its grip on me, it maintains absolute primacy. I lie in bed, recovering from the world's violent dislocation. The mountain outside my window resolves itself, and I lie there, unmoving, looking at it.
